Healthcare rates could be 20% lower than CGHS under Modicare

Date :
29/05/2018

Read: 4 mins

Healthcare rates could be offered at 20% lower than Central Government Health Scheme

The National Health Protection Scheme (NHPS), more commonly known as ‘Modicare’, is set to provide common treatments such as C-section, knee replacement, and coronary bypass surgery at rates that are 15-20% less than what’s offered by the Central Government Health Scheme (CGHS).

As part of this initiative, extensive medical care will be given to government employees – both existing and retired – and their dependent families.

This initiative by the NHPS will cover nearly 1354 packages that have been finalised by the health ministry. From cardiology to oncology to ophthalmology to orthopaedics to urology, about 23 specialities are said to be included in this package. Some even include special treatment for complex diseases similar to cancer.

The outcome of the move

For some treatments, the outcome can mean a reduction of almost Rs 50,000. For instance, a total knee replacement surgery would cost Rs 80,000 and a C-section Rs 9000. Furthermore, Rs 50,000 will be the cost of a vertebral angioplasty with single stent and Rs 65,000 for one with a double stent. The list even includes mental disorders and paediatric surgeries.

To understand the costs better, here are the prices that are likely offered at private hospitals: Rs 1.5 lakh for a C-section, Rs 1.5-2 lakh for angioplasty, and Rs 3.5 lakh for a total knee replacement surgery. Of course, these prices are subject to change, but they do give one a general idea.

NHPS chief executive Indu Bhushan said that CGHS rates were the basis for this scheme. Beneficiaries can exercise their choice to go for a higher number of procedures under the scheme – an advantage offered by the lower prices.

As stated by healthcare experts, not only will new pricing standards come into play, but this act will also result in a fall in health expenses. In turn, this will pressurise healthcare providers to slash the rates they charge from the general public.

How does it benefit individuals?

As per data provided by the socioeconomic and caste census (SECC), more than 10 crore families in need will be protected, with Rs 5 lakh for each family annually. This amounts to almost 50 crore beneficiaries. Procedures that fall under secondary and tertiary care will be covered in this scheme. Moreover, there is no restriction when it comes to age or family size, which safeguards each and every one.

What is covered under the scheme?

Expenses such as registration, general ward boarding, and nursing are covered. Consultation fees, diagnostic tests, procedural expenses, surgical equipment, medicines, and food for the patients are some other aspects that fall under the cover. All this aside, expenses for patient care during follow-up and both pre- and post-hospitalisation will also be taken care of.

If an individual needs to undergo several surgeries, the highest cost of the first treatment will be covered, following which the second and third treatments will only be supported to the extent of 50% and 25% respectively. The remainder of the amount needs to be borne by the individual.

How does it benefit private hospitals?

It’s not just individuals; private hospitals too stand to gain. Those certified at an entry level by the National Accreditation Board for Hospitals & Healthcare Providers (NABH) will acquire 10% more, while those certified at an advanced level have the opportunity to avail an added 15% as an incentive. Hospitals in underdeveloped areas too will attain an extra 10%.

After consulting with the Indian Council of Medical Research (ICMR) and Niti Aayog, the finalised document encompasses particulars about other specifics, such as the minimum number of days to be hospitalised in order to make a claim, along with approval of investigations during pre- and post-surgery.

When is it expected to come into effect?

The document has been distributed to the governments of different states to get an idea of what they think. Additionally, bidding insurers from different states too will get their hands on it. The scheme is expected to come into effect on August 15, 2018, and will be launched by PM Narendra Modi.

Healthcare in India

Healthcare is expensive in India; to an extent where good treatment is denied to many people. Essentially, this scheme targets the underprivileged. Although a master plan, the main cause of concern is viability. The healthcare programme seems comprehensive, and where are the funds going to come from?

Only with time can one tell if this scheme will turn out to be successful or not. If it is, the general public will eventually get to reap a few benefits. Till then, the ones deprived of good healthcare can benefit from the scheme.